German researchers have demonstrated that oral sildenafil, a potent acute pulmonary vasodilator that widens blood vessels, could be a new treatment agent for chronic thromboembolic pulmonary hypertension. The investigators studied 12 patients who suffered from severe pulmonary hypertension. They noted that long-term treatment with sildenafil, over 6-1/2 months, was marked by improved hemodynamics and exercise capacity. All of the relevant parameters for these patients improved significantly, according to the authors. These included mean pulmonary artery pressure, the pulmonary vascular resistance index, the cardiac index, central venous pressure, and 6-minute walk distance. Prior to the trial with sildenafil, all patients had complained of deterioration in their clinical status despite the use of controlled long-term anticoagulation therapy. Also, they had risk factors predictive of poor survival and rapid disease progression. No serious sildenafil-related side effects were reported by the patients. The study is published in the second issue for April 2003 of the American Thoracic Society’s American Journal of Respiratory and Critical Care Medicine.
AFRICAN-AMERICAN CHILDREN HAVE A MUCH HIGHER HOSPITAL READMISSION RATE FOR ASTHMA
African-American children were over 4 times more likely to be readmitted to a hospital for asthma than were youngsters from other races/ethnicities in a large study that utilized 10 years of data from two major university-based children’s hospitals. The investigators looked at patient attributes connected with age, sex, ethnicity, residence, payer status, length of stay, and month of admission. The data was compared with patients admitted once during the 10-year period and those who were admitted multiple times. About 30 percent of the 8,761 patients were admitted more than once. The investigators said that a second admission was an effective time to fully reevaluated risk factors related to that patient. The authors believe that using such an approach is unbiased and avoids characterization of the population at risk by either race/ethnicity or socioeconomic status. Such interventions should focus on improving medication use, adherence to medication regimens, access to appropriate care, and the provision of special attention to the child’s and caregiver’s psychosocial needs. By making appropriate adjustments, perhaps future readmissions could be avoided. The study appears in the second issue for April 2003 of the American Thoracic Society’s peer-reviewed American Journal of Respiratory and Critical Care Medicine.
OLDER AMERICANS WITH COEXISTING RESPIRATORY CONDITIONS ARE PARTICULARLY SUSCEPTIBLE TO THE HARMFUL EFFECTS OF AIR POLLUTION
Older individuals who died from such non-respiratory causes of death as cardiac disease were particularly susceptible to the adverse effects of air pollution if they also had a coexisting respiratory condition. Researchers analyzed mortality data for the New York City area, including deaths in the Bronx, Kings, New York, Queens, and Richmond counties for the years 1985 to 1994. During that period, the population was approximately 7.3 million people. They believe that their study shows that respiratory disease had a more important contributing effect on pollution-related mortality even when a non-respiratory cause of death was listed, such as cardiac disease. The authors point out that controlled studies in humans have shown exposure to concentrated particles from the environment have resulted in pulmonary inflammation and lung injury in adults. Consequently, harmful effects on the lung could affect those with pre-existing circulatory conditions. For example, the researchers note that increased lung permeability could allow pollution particles breathed into the lung to enter the circulation and have either a systemic or a direct effect on cardiac muscle. The research appears in the second issue for April 2003 of the American Thoracic Society’s peer-reviewed American Journal of Respiratory and Critical Care Medicine.
For the complete text of these articles, please see the American Thoracic Society Online Web Site at http://www.atsjournals.org. For either contact information or to request a complimentary journalist subscription to ATS journals online, or if you would like to add your name to the Society’s twice monthly journal news mailing list, contact Cathy Carlomagno at (212) 315-6442, or by e-mail at ccarlomagno@thoracic.org.
Journal
American Journal of Respiratory and Critical Care Medicine